Warning signs
- Painless jaundice, especially with itching
- Unexplained weight loss and loss of appetite
- New diabetes after 50 with weight loss
- Upper-belly or back pain that persists
Diagnosis: EUS-guided biopsy
EUS with a fine needle (FNA/FNB) is the preferred way to sample most pancreatic masses. It's done through the stomach or duodenum, without a cut. Bile duct narrowings can be sampled during ERCP with brushings or, in selected cases, direct cholangioscopy.
Staging and planning
A dedicated CT scan (and sometimes EUS) shows whether the tumour can be removed surgically. Decisions are best made together with surgeons and oncologists.
Relieving blockage
- Jaundice: a stent placed by ERCP, or by EUS if ERCP isn't possible
- Blocked stomach outlet: an enteral stent or, in selected cases, EUS-guided gastrojejunostomy
- Pain: EUS-guided coeliac plexus neurolysis can reduce pain for some people